During a dreadful three-year period between 2005 and 2008 a stay at Stafford Hospital amounted to the very real possibility of an untimely death sentence, particularly for older patients.

That is the chilling but unequivocal finding of an independent report by Robert Francis QC into what the government has termed the “dysfunctional failure” of the Mid Staffordshire NHS Foundation Trust.

Fundamental principles of humanity, never mind the duties and responsibilities of the medical profession, were apparently forgotten about as frail patients literally rotted away in the stench of their own urine and faeces.

And while the Health Secretary, Andy Burnham, has rightly accepted the findings and recommendations of the Francis inquiry, two important questions remain unanswered.

The first, and most obvious, is how could this have happened? How was it that as many as 1,200 people died unexpectedly at Stafford Hospital in the three-year period and the alarm bells were not triggered before it was too late?

The second question is why Mr Burnham and the government feel it “would not be in the best interests of healthcare in Staffordshire” to hold a full public inquiry?

It is easy to see why an open investigation where evidence can be taken in public and on oath might not be in the best interests of NHS bureaucrats and medical staff, but it would surely be in the interests of the families of patients who died at Stafford Hospital.

It is interesting to note that even Mr Burnham accepts that NHS Foundation trusts are not publicly accountable. They are not required to hold meetings in public, something the Minister says he is considering changing, and it remains difficult if not impossible to gain access to the decision making process at organisations that are essentially run along the lines of private businesses.

The replacement of regional and district health authorities, where local councillors were on management boards, with Foundation trust status represents just one example of a 25-year shift away from democratic accountability.

Water authorities were abolished at privatisation, leaving decisions to be taken behind closed doors by company directors. The make-up of police authorities was changed by the government to vastly reduce the number of local council representatives, and chief constables no longer present themselves for questioning at council meetings.

It is in the world of local government that the farthest-reaching changes have taken place, with more and more councils handing responsibility for service provision to arms-length companies, who of course stand to make millions of pounds in profit.

In Birmingham, the outsourcing company Capita is chiefly responsible for delivering a £1 billion business transformation programme, but there are no arrangements for elected councillors to publicly question the company’s managers and directors about their performance.

Birmingham City Council is not Stafford Hospital, but the principle remains the same. Changes supposedly designed to improve efficiency have actually resulted in a worrying democratic deficit.